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Intraoperative Urine Output Is Associated with Postoperative Outcome in Pediatric Population Undergone Major
Chao Zheng1,2, Chunbao Guo2,3
1Department of Orthopedics, Children's Hospital, Chongqing Medical University, Chongqing 400014, People's Republic of China.
Insights
Lower urine output in pediatric patients after Roux-en-Y hepaticojejunostomy correlated with fewer complications and faster recovery. This finding suggests a potential shift in fluid management strategies for these young patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nephrology
Background:
- Roux-en-Y hepaticojejunostomy is a common procedure in pediatric surgery.
- Urine output is often used as an indicator for fluid administration post-surgery.
- Limited data exist on the optimal urine output target for pediatric patients undergoing this procedure.
Purpose of the Study:
- To evaluate postoperative outcomes in pediatric patients undergoing elective Roux-en-Y hepaticojejunostomy.
- To assess the relationship between urine output and key clinical outcomes.
Main Methods:
- Retrospective review of 689 pediatric patients who underwent Roux-en-Y hepaticojejunostomy.
- Patients were divided into low and high urine output groups based on a cutoff of 6.01 mL/kg*h.
- Primary endpoint: renal complications. Secondary endpoints: gastrointestinal function recovery, other postoperative complications, and hospital stay.
Main Results:
- Lower urine output was associated with reduced crystalloid fluid administration.
- Patients with lower urine output showed a trend towards fewer grade II postoperative complications and faster gastrointestinal function recovery (first flatus and bowel movement).
- No significant difference in renal complications was observed; however, hospital stay was shorter in the low urine output group.
Conclusions:
- Lower urine output is linked to decreased postoperative complications and improved gastrointestinal recovery in pediatric hepaticojejunostomy patients.
- This outcome occurs without an increased risk of renal complications.
- Further research is needed to determine optimal urine output targets and fluid administration strategies.
Aim:
Few data support the advantage of confirming a low urine output target during Roux-en-Y hepaticojejunostomy, which was widely used as an indication for fluid administration. We aimed at evaluating postoperative outcomes in terms of urine output in pediatric patients undergoing elective Roux-en-Y hepaticojejunostomy.
Methods:
We retrospectively reviewed 689 patients who had undergone Roux-en-Y hepaticojejunostomy between January 2007 and August 2014 at the Children's Hospital of the Chongqing Medical University. Patients were dichotomized according to the average amount of corrected urine output (6.01 mL/kg*h) as a cut-off point. The primary endpoint was the occurrence of renal complications. The secondary endpoints included prompt postoperative gastrointestinal function recovery, postoperative complications and hospital length of stay.
Results:
The lower urine output had a proportional association with lesser amounts of crystalloid fluids (12.99±6.52 and 17.36±7.74 mL/kg*h for low and high urine output, respectively, p=0.006). For patients with a lower urine output, there were trends toward lower incidence rates of grade II postoperative complications (OR, 0.68; 95CI, 0.45-1.03; p=0.041) and accelerated recovery of gastrointestinal function, as indicated by the first flatus (p=0.015) and first bowel movement (p=0.008); however, the occurrence of renal complications did not show significant differences between the groups. The total length of hospital stay was shorter in patients with low urine output (7.59±1.24 days) than that in patients with a high urine output (8.01±2.31 days, p = 0.016).
Conclusion:
Lower urine output is associated with a lower incidence rate II postoperative complications and accelerated recovery of gastrointestinal function, without increasing the occurrence of renal complications in pediatric patient undergone hepaticojejunostomy. The optimal amount of urine output and associated fluid administration should be further investigated.
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